My father had two sisters I never knew. In the little town where they were born, early in the 20th century, they did not see their second birthdays. They had fever.
The situation was so dire that my grandfather went to the prayer house to change his daughter’s name to fool the angel of death. This happened twice. It did no good.
In 1850, four in 10 English babies died before their first birthday. Lethal epidemics swept through crowded cities, as people were packed into dark, dirty rooms with fetid air and no running water. Familiar scourges included cholera, pneumonia, scarlet fever, diphtheria, whooping cough, tuberculosis and smallpox.
Today, fewer than five of every thousand infants in Britain are expected to die before the age of one – a remarkable improvement. Over the past 150 years, most countries have been getting healthier. Chalk it up to improved sanitation, rat control, clean drinking water, pasteurised milk, childhood vaccinations, modern medical procedures and, of course, 70 years of antibiotics. In today’s world, children grow up without deformed bones or “cloudy” sinuses from infections.
Nearly all women survive childbirth. Eighty-year-olds, once consigned to the veranda, are swatting tennis balls, often with the help of a metallic hip joint.
Yet recently, just within the past few decades, amid all of these medical advances, something has gone terribly wrong. In many ways, we appear to be getting sicker. You can see the headlines every day. We are suffering from an array of what I call “modern plagues”: obesity, childhood diabetes, asthma, hay fever, food allergies, oesophageal reflux and cancer, coeliac disease, Crohn’s disease, ulcerative colitis, autism, eczema.
In all likelihood, you or someone in your family or someone you know is afflicted. Unlike most lethal plagues of the past that struck relatively fast and hard, these are chronic conditions that diminish and degrade their victims’ quality of life for decades. The most visible of these plagues is obesity.
Britain is the fattest nation in western Europe, with more than a quarter of the population ranked obese. The UK figure of 26.1% is more than twice that of France, at 12.9%; the Australian rate is even higher, at 28%. Next time you go to an airport terminal or supermarket, look around and see for yourself.
The obesity epidemic is global. As of 2008, according to the World Health Organisation, 1.4 billion adults were overweight; of these, more than 200 million men and nearly 300 million women qualified as obese. Many of these people live in developing countries that we associate more with famine than overeating.
These figures are alarming but what is really shocking is that this global human body fat accumulation has been accelerating not over the course of a few centuries, but in a mere two decades.
Yet fat- and sugar-rich foods, so often blamed for all the extra pounds, have been ubiquitous for a good deal longer than that, at least in the developed world, and the new generations of overweight people in the developing world have not suddenly adopted a Kentucky-fried, American-style diet. Epidemiological studies have shown that high caloric intake, while definitely not helpful, is not sufficient to explain the distribution or course of the worldwide obesity epidemic.
At the same time, the autoimmune form of diabetes that begins in childhood and requires insulin injections (juvenile or type 1 diabetes) has been doubling in incidence about every 20 years across the industrialised world; in Finland, where record-keeping is meticulous, the incidence has risen by 550% since 1950.
This increase is not because we are detecting type 1 diabetes more readily. Before insulin was discovered in the 1920s, the disease was always fatal. Nowadays, with adequate treatment, most children survive. But the disease itself has not changed; something in us has changed. Type 1 diabetes is also striking younger children. The average age of diagnosis used to be about nine. Now it is around six, and some children are becoming diabetic when they are two.
The recent rise in asthma, a chronic inflammation of the airways, is similarly alarming. There are 5.4 million people with asthma in the UK, affecting one in five households. One in 12 adults is afflicted. One in every 11 children suffers from the wheezing, breathlessness, chest tightness and coughing emblematic of asthma. Two million Australians, 10% of the population, also suffer from the condition.
The rate of childhood asthmas increased by 50% from 2001 through 2009 in the US, and the rise in asthma did not spare any ethnicity; the rates were initially different in various groups, and all have been rising.
Asthma is often triggered by something in the environment such as tobacco smoke, mould, air pollution, cockroach droppings, colds and flu. Once an attack begins, asthmatics gasp for air and, without rapid access to medication, are rushed to emergency rooms. Even with the best care, they can die.
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